Tan Hongna, Yang Benlong, Wu Jiong, Wana Shengping, Gu Yajia, Li Wentao, Jiang Zhaoxia, Qian Min, Peng Weijun
Department of Radiology, Cancer Hospital/Institute, Shanghai Medical College, Fudan University, Shanghai, China.
J Comput Assist Tomogr. 2011 May-Jun;35(3):367-74. doi: 10.1097/RCT.0b013e318213ccd9.
This study aimed to determine the accuracy of computed tomographic (CT) localization and CT-based diagnosis of sentinel lymph nodes (SLNs) metastasis.
Thirty-four patients with confirmed breast cancer underwent 40-row CT scanning, and the first one or several lymph node(s) in the lymphatic drainage pathway was/were defined as the SLN(s). Dye and γ probe-guided SLN biopsy was performed on all patients. To accurately localize the SLN, 19 patients (55.9%) underwent the percutaneous lymph node puncture procedure. The morphologic features of all the SLNs on CT scans were analyzed and compared with the SLN biopsy pathologic diagnosis.
Sentinel lymph nodes were successfully identified for all patients without any significant adverse effects. All localized SLNs corresponded well with SLNs identified on SLN biopsy, with an accuracy of 89.5%. Accuracy increased to 100% when the CT scan technique was combined with the blue dye method. The size criteria for metastatic diagnosis had a sensitivity of 85%, which increased to 94.7% when long-to-short-axis ratio and margin characteristics were also considered.
The CT lymphography combined with the blue dye method accurately localized the SLNs. The CT-based diagnostic criteria improved the diagnostic accuracy of SLN metastases and were useful for evaluating the axillary status in early stage breast cancer patients.
本研究旨在确定计算机断层扫描（CT）定位及基于CT诊断前哨淋巴结（SLN）转移的准确性。
34例确诊为乳腺癌的患者接受了40排CT扫描，将淋巴引流途径中的首个或数个淋巴结定义为前哨淋巴结。所有患者均进行了染料及γ探针引导下的前哨淋巴结活检。为准确对前哨淋巴结进行定位，19例患者（55.9%）接受了经皮淋巴结穿刺操作。分析了CT扫描上所有前哨淋巴结的形态特征，并与前哨淋巴结活检病理诊断结果进行比较。
所有患者均成功识别出前哨淋巴结，且无任何明显不良反应。所有定位的前哨淋巴结与前哨淋巴结活检所识别的淋巴结高度吻合，准确率为89.5%。当CT扫描技术与蓝色染料法联合使用时，准确率提高至100%。转移诊断的大小标准灵敏度为85%，若同时考虑长短轴比值及边缘特征，灵敏度则提高至94.7%。
CT淋巴造影联合蓝色染料法可准确对前哨淋巴结进行定位。基于CT的诊断标准提高了前哨淋巴结转移的诊断准确性，有助于评估早期乳腺癌患者的腋窝状况。
